To examine the available evidence on the effects of care and support provided by volunteers on the health outcomes of older adults in acute care services.
Acute hospital inpatient populations are becoming older and this presents the potential for poorer health outcomes. Factors such as chronic health conditions, polypharmacy, and cognitive and functional decline are associated with increased risk of healthcare‐related harm, such as falls, delirium, and poor nutrition. To minimise the risk of healthcare‐related harm, volunteer programs to support patient care have been established in many hospitals worldwide.
A systematic scoping review.
The review followed the PRISMA Checklist for Scoping Reviews (PRISMA‐ScR) (see Supplementary File 1). Nine databases were searched (CINAHL, MEDLINE, EMBASE, COCHRANE, SCOPUS, WEB of SCIENCE, PUBMED, SCIENCE DIRECT and JBI) using the following key terms: ‘hospital', ‘volunteer', ‘sitter', ‘acute care', ‘older adults', ‘confusion', ‘dementia' and ‘frail'. The search was limited to papers written in English and published from 2002‐2017. Inclusion criteria were studies involving the use of hospital volunteers in the care or support of older adult patients aged ≥65 years, or ≥50 years for Indigenous peoples, with chronic health conditions, cognitive impairment and/or physical decline or frailty, within the acute inpatient settings.
Of the 199 articles identified, 17 articles that met the inclusion criteria were critically appraised for quality, and 12 articles were included in the final review.
There is evidence that the provision of volunteer care and support with eating and drinking, mobilising, and therapeutic activities, can impact positively upon patient health outcomes related to nutrition, falls, and delirium. Further robust research is needed to determine the impact of volunteers in acute care and the specific care activities that can contribute to the best outcomes for older adults.
Volunteers can play a valuable role in supporting care delivery by nurses and other health professionals in acute care services, and their contribution can improve health outcomes for older adults in this setting.
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Despite the publication of hundreds of trials on gout and hyperuricemia, management of these conditions remains suboptimal. We aimed to assess the quality and consistency of guidance documents for gout and hyperuricemia.
Systematic review and quality assessment using the appraisal of guidelines for research and evaluation (AGREE) II methodology.
PubMed and EMBASE (27 October 2016), two Chinese academic databases, eight guideline databases, and Google and Google scholar (July 2017).
We included the latest version of international and national/regional clinical practice guidelines and consensus statements for diagnosis and/or treatment of hyperuricemia and gout, published in English or Chinese.
Two reviewers independently screened searched items and extracted data. Four reviewers independently scored documents using AGREE II. Recommendations from all documents were tabulated and visualised in a coloured grid.
Twenty-four guidance documents (16 clinical practice guidelines and 8 consensus statements) published between 2003 and 2017 were included. Included documents performed well in the domains of scope and purpose (median 85.4%, range 66.7%–100.0%) and clarity of presentation (median 79.2%, range 48.6%–98.6%), but unsatisfactory in applicability (median 10.9%, range 0.0%–66.7%) and editorial independence (median 28.1%, range 0.0%–83.3%). The 2017 British Society of Rheumatology guideline received the highest scores. Recommendations were concordant on the target serum uric acid level for long-term control, on some indications for urate-lowering therapy (ULT), and on the first-line drugs for ULT and for acute attack. Substantially inconsistent recommendations were provided for many items, especially for the timing of initiation of ULT and for treatment for asymptomatic hyperuricemia.
Methodological quality needs improvement in guidance documents on gout and hyperuricemia. Evidence for certain clinical questions is lacking, despite numerous trials in this field. Promoting standard guidance development methods and synthesising high-quality clinical evidence are potential approaches to reduce recommendation inconsistencies.
Medications with anticholinergic activity are used in the treatment of many diseases common in old age, including depression, psychosis, Parkinson’s disease, allergies, pain and urinary incontinence. A high anticholinergic burden (ACB) is considered a major risk factor for fractures in older adults but recent studies reported inconsistent results. These inconsistencies may partly be due to differences in methodological aspects. However, no systematic review so far has addressed this association and considered study methods. Thus, we aim to conduct a systematic review and meta-analysis of observational studies addressing the association of ACB with fractures and to provide a methodological appraisal of the included studies.
We will search MEDLINE, EMBASE, the Science Citation Index, CENTRAL and grey literature using a strategy that combines the terms anticholinergic and fractures. We will hand search reference lists of articles. Two reviewers will independently screen all identified abstracts for eligibility and evaluate the risk of bias of the included studies using the Newcastle-Ottawa Quality Assessment Scale and RTI item bank. Discrepancies will be resolved by consensus or consultation with a third researcher. We will conduct a meta-analysis, either for the overall population or for specific and more homogeneous subgroups, if the number of studies retrieved and their heterogeneity allows it.
No ethics approval will be sought, as no original data will be collected for this review. Findings will be disseminated through peer-reviewed publication and conference presentations.
Millions of patients are currently suffering from pain and dysfunction caused by osteoarthritis (OA), and billions of dollars have been invested into treatment. Because there is no effective treatment that can reverse the progression of knee OA, it is important to determine the risk factors that may influence the progression. However, although there are many studies that examine risk factors for progression, there are only a few that specifically focus on the impact of each risk factor for predicting progression of knee OA. This study aimed to develop a cohort of patients with primary knee OA in the Beijing area to establish models that identify the influence of each risk factor on the prediction of knee OA progression.
This is a prospective, multicentre, hospital-based cohort study. The study population comprises 2000 patients with primary knee OA from the Beijing area. The recruitment and baseline visits started in December 2017 and will finish in November 2018. After baseline visits, the patients will be followed for 3 years or until the occurrence of primary outcomes. Demographic variables will be collected during the baseline visit. Influencing factors including occupational exposures, family history and treatment will be collected at baseline and each follow-up visit. The primary outcome measure is a comprehensive index which will be combined with clinical WOMAC score, imaging K-L grade and clinical outcomes. These data will also be collected at baseline and each follow-up visit.
This study protocol has been approved by Peking University Third Hospital Medical Science Research Ethics Committee. All the eligible participants will give written informed consent. The findings will be published in peer-reviewed journals and presented at national or international conferences. Besides, the results will be disseminated to all participants via the social software ‘WeChat’.
The objective of this meta-analysis was to assess whether depression in percutaneous coronary intervention (PCI) patients is associated with higher risk of adverse outcomes.
Systematic review and meta-analysis.
EMBASE, PubMed, CINAHL and PsycINFO were searched as data sources. We selected prospective cohort studies evaluating the relationship between depression and any adverse medical outcome, including all-cause mortality, cardiac mortality and non-fatal events, from inception to 28 February 2019. Two reviewers independently extracted information and calculated the risk of cardiovascular events in patients with preoperative or postoperative depression compared with non-depressed patients.
Eight studies (n=3297) met our inclusion criteria. Most studies found a positive association between depression and adverse cardiovascular outcomes. Meta-analysis yielded an aggregate risk ratio of 1.57 (95% CI 1.28 to 1.92, p
Our systematic review and meta-analysis suggests that depression is associated with an increased risk of worse clinical outcome or mortality in patients undergoing PCI. Assessment time and length of follow-up do not have a significant effect on this conclusion.
To assess the self‐management activities among rural patients with chronic hepatitis B (CHB), and the influence of psychosocial and demographic factors on their self‐management activities.
Chronic hepatitis B is a serious public health concern. Rural patients may have limited access to healthcare services. Although self‐management is important for controlling chronic hepatitis B, few studies focus on the self‐management activities among rural patients with chronic hepatitis B. Understanding self‐management activities and related factors in this population are important to design and implement appropriate intervention strategies.
A cross‐sectional study.
From June–December 2017, totally 236 rural patients with chronic hepatitis B were recruited from hepatology department in two hospitals in Chongqing, China. The questionnaire included demographic characteristics, Chronic Hepatitis B Self‐Management Scale, Self‐Efficacy for Managing Chronic Disease, and Social Support Rating Scale. The study followed the STROBE checklist.
Rural patients with chronic hepatitis B reported poor self‐management activities for the score indexes of symptom management (57.36%), lifestyle management (54.89%), psychosocial coping (54.84%) and disease information management (53.11%) were all below 60%. Self‐efficacy, objective support, subjective support, gender, education level and marital status showed significant effect on self‐management activities.
Rural patients with chronic hepatitis B were found to perform insufficient self‐management activities. Self‐efficacy, social support, gender, education level and marital status were identified to influence their self‐management activities.
Self‐management activities should be promoted among rural patients with chronic hepatitis B. The factors that were identified in this study should be addressed when developing interventions to promote the performance of self‐management activities for rural patients with chronic hepatitis B.
To explore the experiences of first‐year nursing students, their motivations for working and how they juggled study and other commitments while engaging in paid work.
There has been a global rise in the number of students balancing full‐time study, paid work and other commitments, with the main antecedent financial reasons.
Qualitative exploratory study.
Drawn from a larger Australasian sequential exploratory mixed‐method study, this qualitative study was conducted with fifty first‐year undergraduate nursing and midwifery students who commenced their nursing studies in 2017. Telephone or face‐to‐face interviews were conducted with purposively selected students engaged in either nursing or non‐nursing fields of work. Interviews were conducted from April–July 2017. Interviews lasted from 15–40 min. Results were thematically analysed. EQUATOR guidelines for qualitative research (COREQ) applied.
Two main themes and accompanying subthemes were identified. The first theme explored students’ motivation behind combining work and study and identified the need for financial security and “me time”. The second theme “Juggling many balls” provided insights into the benefits students perceived, how they kept the “balls” in the air and at times dropped “balls” while balancing work, study and other commitments.
The motivation behind paid work was mainly financial; however, students also reported work allowed an escape and time for self which had social and health benefits. Working provided a range of positive benefits, including a sense of achievement, improved self‐esteem and financial independence.
Being able to juggle and multi‐task improved skills such as organisation and the ability to prioritise, all skills that have applicability for the role as registered nurse.
Introducción: los pacientes que se encuentran hospitalizados sufren un conjunto de reacciones y sentimientos que conlleva generalmente proble-mas de sueño en el hospital, donde el trabajo es continuo en relación a los cuidados que requieren los pacientes y donde es necesario considerar la tecnología que caracteriza a las diferentes unidades, por el ruido que se produce y la luz que requieren los profesionales para llevar a cabo el trabajo. El ruido y la luz son los factores ambientales que afectan en mayor medida a los pacientes hospitalizados. El objetivo es comprobar, identifi-car y discutir cuales son los factores perturbadores ambientales que afectan al sueño/descanso de los pacientes ingresados en el hospital. Material y métodos: se llevó a cabo una búsqueda bibliográfica en las principales bases de datos primarias y secundarias como Pubmed®, CINAHL®, Coch-rane® y Google Acádemico® de los últimos 10 años. Resultados: se obtuvo un gran número de artículos, de los cuales se seleccionaron los que fueron más relevantes según el objetivo de esta revisión narrativa crítica. Discusión y conclusiones: existe una gran complejidad y variabilidad en las metodologías de los diferentes estudios relacionados con factores perturbadores ambientales, pero también en los últimos años se está prestando mayor atención a la investigación sobre los factores que afectan a sueño y descanso de los pacientes ingresados en el hospital. Se puede concluir que el ruido y la luz son los factores perturbadores ambientales principales que afectan al sueño/descanso de los pacientes hospitalizados y que se necesita más investigación de alta calidad para superar las limitaciones y dificultades de estudios previos y fortalecer los cuidados de enfermería basados en la evidencia.
by Christian Rominger, Ilona Papousek, Andreas Fink, Corinna M. Perchtold, Helmut K. Lackner, Elisabeth M. Weiss, Andreas R. SchwerdtfegerCoping with mental challenges is vital to everyday functioning. In accordance with prominent theories, the adaptive and flexible adjustment of the organism to daily demands is well expressed in task-related changes of cardiac vagal control. While many mental challenges are associated with increased effort and associated decreased task-related heart rate variability (HRV), some cognitive challenges go along with HRV increases. Especially creativity represents a cognitive process, which not only results from mental effort but also from spontaneous modes of thinking. Critically, creativity and HRV are associated with regular exercising and fitness. Furthermore, the cross-stressor adaptation theory suggests that changes in cardiac reactions to physical challenges may generalize to mental challenges. In line with this idea the amount of regular exercising was hypothesized to moderate the association between HRV changes and creativity. A sample of 97 participants was investigated. They reported the amount of regular exercise and their ECG was measured at baseline and during a creativity task. An association between task-related HRV changes and originality as a function of participants’ amount of regular exercise was found. Participants reporting more regular exercising produced more original ideas when they had higher HRV increases during the task, while more sedentary participants showed the opposite association. Results suggest that individuals with a higher amount of regular exercise achieve higher originality probably via the engagement in more spontaneous modes of thinking, while more sedentary people may primarily benefit from increased mental effort. This supports the conclusion that higher creativity can be achieved by different strategies.
Aim of this study was to describe the experiences of intensive care unit (ICU) nurses, physicians and relatives of (potentially) brain dead patients; and to develop recommendations to optimize the workflows on ICUs.
Limited published information on caring for brain dead patients suggest it to be a burden for the nursing staff. It also remains unclear how physicians and relatives of (potentially) brain dead patients perceive these experiences.
Interpretive phenomenology according to Benner.
Medical caregivers (nurses’ und physicians) from multiple wards in a German University Medical Center and relatives of (potentially) brain dead patients will be interviewed. Data collection will include episodic interviews with participants’ experiences in care of (potentially) brain dead patients. The study is funded by the Ministry of Science, Research and the Arts, Baden‐Württemberg (1 February 2016).
Gaining insights into caring for (potentially) brain dead patients and its associated burden will lead to the development of better recommendations to assist all people involved.
Expand the understanding of the experience of healthcare professionals in the care for (potentially) brain dead patients. Understand the experience of relatives of (potentially) brain dead patients. Findings from this study will support the development of recommendations for action by a multi‐professional expert group consisting of nurses, physicians, healthcare managers and patient advocates.
Trial registration: Protocol version. German Register for Clinical Studies (Registration No. DRKS00010420) Database of Health Services Research Germany (Project Nr. VfD_16_003710).
Los buenos educadores son vitales como referentes en la formación de los docentes noveles y de estudiantes de enfermería.
Objetivo: Explorar aspectos trascendentes para el desempeño docente de los buenos formadores en enfermería, desde sus propias perspectivas y en ámbitos de su historia personal y profesional.
Materiales y métodos: Investigación cualitativa, tipo estudio de caso. Se identificaron a los mejores educadores consultando estudiantes y docentes de dos Escuelas Universitarias de Enfermería de Barcelona. Se utilizaron entrevistas, observaciones participantes y diario del profesor. Además, se usaron criterios de rigor científico, consentimiento informado y sistema de identificadores, asegurando confidencialidad y anonimato.
Resultados: Se describieron como trascendentes para su desempeño, la influencia de modelos como padres y docentes clínicos, el valor de la relación docente-estudiante, la intuición pedagógica y la relevancia del escenario de la práctica clínica.
Discusión y Conclusiones: Variados aspectos de la vida personal e historia profesional fueron influyentes para el desempeño como buenos educadores, con una potente coherencia entre el actuar profesional y el formador, corroborando la relevancia que adquiere el conocimiento práctico construido en base a experiencias personales sin requerir necesaria participación en programas formales de formación pedagógica.
Palabras claves: Educación en enfermería, testimonio de experto, docentes, investigación cualitativa
Many treatments have been described for pilonidal disease, but recurrence cannot be completely eliminated. The aim of this study was to perform a meta‐analysis of randomised, controlled trials comparing flap repair vs the laying open technique and/or excision and direct closure techniques in the treatment of chronic pilonidal sinus disease. The primary outcome measure was the recurrence rate. Secondary outcomes were complete wound‐healing time, duration of the incapacity to work, quality of life and patient satisfaction, postoperative pain, wound infection, bleeding or haematoma, skin wound complications, and duration of hospital stay. Seventeen studies were included. The meta‐analysis demonstrated a lower risk of recurrence, a shorter duration of incapacity to work, a lower risk of wound infections, a lower risk of skin wound complications, and a shorter duration of hospitalisation in favour of flap vs direct closure. A shorter time to complete wound healing and a shorter duration of incapacity to work for flap vs the laying open technique were observed.
Superiority of flap repair vs direct closure in pilonidal sinus treatment was demonstrated in this meta‐analysis. These results suggest avoiding primary direct closure in clinical practice. Compared with the laying open technique, flaps result in faster healing and a shorter time to return to activities.
Bacterial collagenase from the aerobic non‐pathogenic Vibrio alginolyticus chemovar iophagus is an extracellular metalloproteinase. This collagenase preparation is obtained through a fermentation process and is purified chromatographically, resulting in a highly purified 82‐kDa single‐band protein that does not contain non‐specific proteases or other microbial impurities. V. alginolyticus collagenase was added to a hyaluronan (HA)‐based device to develop a novel debriding agent to improve the treatment of ulcers, necrotic burns, and decubitus in the initial phase of wound bed preparation. In this study, an in vitro biochemical characterisation of V. alginolyticus collagenase versus a commercial preparation from a Clostridium histolyticum strain on various dermal extracellular matrix (ECM) substrates was performed. V. alginolyticus collagenase demonstrated its ability to carry out the enzymatic cleavage of the substrate, allowing a selective removal of necrotic tissues while sparing healthy tissue, as reported in clinical studies and through routine clinical experience. in vitro tests under physiological conditions (pH, presence of Ca++, etc.) have demonstrated that V. alginolyticus collagenase exhibits very poor/limited non‐specific proteolytic activity, whereas the collagenase preparation from C. histolyticum is highly active both on collagen and on non‐collagenic substrates. This finding implies that while the V. alginolyticus enzyme is fully active on the collagen filaments that anchor the necrotic tissue to the wound bed, it does not degrade other minor, but structurally important, components of the dermal ECM. This feature could explain why collagenase preparation from V. alginolyticus has been reported to be much gentler on perilesional, healthy skin.
Statistical interpretation of data collected in a randomised controlled trial (RCT) is conducted on the intention‐to‐treat (ITT) and/or the per‐protocol (PP) study populations. ITT analysis is a comparison of treatment groups including all patients as originally allocated after randomisation regardless if treatment was initiated or completed. PP analysis is a comparison of treatment groups including only those patients who completed the treatment as originally allocated, although it is often criticised because of its potential to instil bias. A previous report from an RCT conducted to evaluate the efficacy of dehydrated human amnion/chorion membrane allograft (EpiFix) as an adjunct to standard comprehensive wound therapy consisting of moist dressings and multi‐layer compression in the healing of venous leg ulcers (VLUs) only reported PP study results (n = 109, 52 EpiFix and 57 standard care patients), although there were 128 patients randomised: 64 to the EpiFix group and 64 to the standard care group. Primary study outcome was the incidence of healing at 12 weeks. The purpose of the present study is to report ITT results on all 128 randomised subjects and assess if both ITT and PP data analyses arrive at the same conclusion of the efficacy of EpiFix as a treatment for VLU. Rates of healing for the ITT and PP populations were, respectively, 50% and 60% for those receiving EpiFix and 31% and 35% for those in the standard care cohort. Within both ITT and PP analyses, these differences were statistically significant; P = 0.0473, ITT and P = 0.0128, PP. The Kaplan‐Meier plot of time to heal within 12 weeks for the ITT and PP populations demonstrated a superior wound‐healing trajectory for EpiFix compared with VLUs treated with standard care alone. These data provide clinicians and health policymakers an additional level of assurance regarding the effectiveness of EpiFix.
To determine midwives' preference for “Hands‐on” and “Hands‐off/poised” methods and to explore the impact factors.
With the increasing rate of obstetric anal sphincter injuries, great controversy surrounds the “Hands‐on” or “Hands‐off” method during childbirth to decrease obstetric anal sphincter injuries incidence. Without regular records and related research, determining the use of this technique in China is difficult.
This study used a quantitative study design, following the EQUATOR guidelines (STROBE).
A nationwide cross‐sectional online survey was conducted using respondent‐driven sampling across 31 provinces in China from 1st October 2017–31st December 2017. A total of 6,425 midwives were involved. Descriptive analyses, chi‐square test and binary logistic regression were undertaken.
A total of 5,225 questionnaires were returned; 55.8% of the participants preferred the “Hands‐off/poised” method. The impact factors included hospital categories, total work experience in a birth unit in years, theoretical education and skill training. In the study, for situations with increased OASI risk, 100% of the midwives in the “Hands‐off” group expressed willingness to change to the “Hands‐on” method whether there was concern about impending obstetric anal sphincter injuries.
The “Hands‐off/poised” method is heavily practised by Chinese midwives. However, majority of the midwives adopt “Hands‐on” method in the face of high risk for obstetric anal sphincter injuries. Further studies are needed to determine the association between obstetric anal sphincter injuries rate and perineal management for low‐risk birth.
The result indirectly illustrates the application of “Hands‐off/poised” technique in China and provides evidence for the international midwifery organisation to understand the status of Chinese midwifery to some extent. It also provides the latest data for further study of these two methods and the study of the relationship between hands‐off/poised method and obstetric anal sphincter injuries.